Physicians for Human Rights applauds the upcoming introduction of the United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (known as the PEPFAR reauthorization bill) in to the House of Representatives and strongly supports the bill's call for at least $50 billion over five years. The bill that will be introduced on Wednesday was developed under the leadership of the late Rep. Tom Lantos, and passing it would be a tribute to a great champion of global health and human rights.

President Bush has proposed spending only $30 billion over five years for the program, a level which would hinder HIV prevention efforts and slow treatment of new patients. Only 100,000 new patients per year could be started on HIV drugs, when millions are dying without treatment.

"Only a small fraction of people with AIDS in Africa are getting the medicines that will keep them alive," said John Bradshaw, JD, Director of PHR's Washington Office. "Now is not the time to slow down."

White House officials contend that the program cannot absorb more money, but PHR points to its research into Africa's health infrastructure. "African countries urgently need more health workers to implement PEPFAR programs, and the new Lantos bill would help by training and retaining thousands of them," said Bradshaw.

Among many useful provisions, the bill would greatly strengthen programs for women and young girls, who are physically, socially, and economically more vulnerable to HIV infection. Presently women compromise 61% of HIV cases among adult subSaharan Africans, and as many as 75% of the young people infected with HIV in the region are female.

The bill would support interventions that elevate the status of women, who are often at the lowest rung of society. It would, for instance, promote basic education for women and promote the property and inheritance rights of women, two factors which have been linked to vulnerability to HIV/AIDS.

The new bill would link AIDS services to other health services women need, such as family planning and maternal-child services. The bill would also support the integration of primary care and HIV prevention, care and treatment programs which have proven to decrease HIV incidence and stigma and reduce overall cost.

PHR is calling for PEPFAR 2 to train, retain, and support at least 140,000 new African health workers—the US's fair share of health workers needed to achieve universal access to HIV programs. PHR's field work and feedback from the group's large network of allies in Uganda and Kenya indicates that this is a critical problem that often prevents the effective use of PEPFAR monies and should be addressed in reauthorization legislation.

In addition, the bill would support the development of five year plans from each country to address its health worker crisis, would provide technical assistance for countries that seek to strengthen their health workforces and would help them track and better utilize the health workers they do have.

The bill would also explicitly support safer working conditions for health workers, who often must tend to sick patients without masks, gloves, or other basic equipment.

BACKGROUND

Rep. Berman is expected to introduce the House version of the bill on February 27 since he is acting chair of the House Foreign Affairs Committee--Rep. Lantos was a powerful force behind reauthorization of PEPFAR up until his death.

There are two versions of the bill, substantially different, circulating in the House; a Senate version is not expected for a couple of more months.

The Administration and Republicans in the House think PEPFAR is fine as it is and are resisting nearly all of the evidence-based changes Democrats (and global health organizations) are introducing. The Lantos bill pushes for far greater focus on HIV prevention among women, who comprise 61% of people with HIV in sub-Saharan Africa and as many as 75% of young people with HIV in the region. Lantos' bill would offer strong support to programs that scientific evidence has shown helps prevent HIV in women--and also protect their human rights. "Abstinence and Be Faithful" (AB) programs were a central focus of PEPFAR 1, but evidence from the field shows that these programs are inadequate to address the needs of women who have no ability to control who they have sex with, let alone demand that a condom is used.

The Lantos bill would fund programs that lift the status of women—like microloans and access to food—which have been shown to reduce HIV transmission. Where they have human rights, women have the ability to protect themselves. The Lantos bill would also integrate reproductive health services, and other basic health services, with AIDS care so that there is one-stop shopping for patients, and AIDS money can reach broader populations. This would also eliminate the stigma for women—and others—that prevents them from walking into an AIDS clinic—they would just be walking into any health clinic.

The Lantos bill would help stem Africa's vast health worker shortage—a major stumbling block that is currently preventing PEPFAR money from reaching people with AIDS who need it, according to the World Bank and the World Health Organization. The World Health Organization estimates that Africa needs more than one million additional health workers—and the Lantos bill would push for a minimum number of such workers and fair distribution of them throughout rural areas. The Republican version of the bill strips out this language, potentially crippling the overall program.

PHR calls for PEPFAR 2 to train, retain, and support at least 140,000 new African health workers—the US's fair share of health workers needed to achieve universal access to HIV programs. PHR's field work and feedback from the group's large network of allies in Uganda and Kenya indicates that this is a critical problem that prevents the best use of PEPFAR monies and should be addressed in reauthorization legislation.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.